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O Environmental Health Department <br /> ti , <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any IN oWons hoteid in the "Iyotico to Comp y° in the r3rttm hoo Inspection Report Must be carngotggwithIn M am of <br /> rsc®ipt of nspecrtibrL This csrtifioetion form must be subinhed tothe Environmental Health Department (Elan) fiddrew <br /> at the top (s form within 30 trays of raoeipt of the inspection Report H8C 254D4A -2(c}(1 ) <br /> AN other vldgka noted in the aUsctwl Irrspectlon Report QR) or Continuation Form, yr disputes to any <br /> vidlations, to be spbmitied using this cartification and ratumed try EHD li;Mfn N daysdays unless othatWee spOlied in ttia <br /> Insp6e io ort HSC 251 85(t)(3) <br /> iNsl HD staff time aseaclMd with failing to comply by the above nc tad dates Will be <br /> at the cufreint houo idle. <br /> For thl rtification to be complete, the operator of the site must include: <br /> ant dart MarWng whet corrective actions were taken or will be taken for each violation <br /> of "ample resullWmanlfeats/treining recordslother appropriate paperwork, andlor photos verifying <br /> ons <br /> duelP gOt�I wflgh P i .' . . t • . <br /> tnspe Delta: N!�aLU9I 2019 Inspectaid By; CLAUDIA MURQ <br /> Facati ty iresso 336 F Kr=TTLEMAN LN, LODI _ CERS 11M 10187053 <br /> I certify u r analty of laW thAt: <br /> 1 ,, I corrmcped the violations spew ted In .the InspeLton Report from the above-mentioned inapeciQn-date. , <br /> 20 1 pmrsonally exerained the following documentation submitted as proof of compliance FOR EACH VICILAT1t5N <br /> a 1 Wieve the Information to be true, arxurate, and com fete: <br /> . . .�. <br /> Photos eperwgrlc Statement <br /> 31 i Utherized to submit this corifff6tfon on behalf ofthe 'Ri mpondent• <br /> 4, i iware that theirs are significant OenmlNea for submitting f ilaa information, induclio8 tit9 posisibility of a fine <br /> e im doonment for known vlolattQne , (HBC 2519.1 ) <br /> Vi <br /> Na <br /> Sign __Date:Wart <br /> fit _ <br /> I <br /> At <br /> i <br /> i <br /> I <br /> i <br /> i <br /> B i . Hazlltori Avenue l Stockton, California 962051 T 209 468I,,3Q0 l F 20946440138 www.siceftoom <br />